| NPI | 1598770190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL PORT Owner 360-373-0622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: WA CF00002273) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2020-08-22 |